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Are Ohio Prescribers and Pharmacies Prepared for the New Requirement to Include ICD-10 Diagnosis Codes on All Controlled Substance Prescriptions?

We previously reported that on March 30, 2017, Ohio Gov. John Kasich and the executive directors of Ohio’s health care licensing agencies announced new standards for prescribing opiates for acute pain.  Following that announcement, the State of Ohio Board of Pharmacy proposed rules that, if adopted, will increase the scope of the previously proposed standards by requiring prescribers to include an ICD-10 diagnosis code on all prescriptions for controlled substances, not just opiate pain medications.  The new proposed rules aim to include controlled substances that treat conditions such as attention deficit disorder, low testosterone, narcolepsy, and seizure disorders.

On July 28, 2017, associations advocating on behalf of doctors and hospitals reached a compromise with Gov. Kasich’s office and the State Medical Board of Ohio, under which prescribers must begin reporting ICD-10 codes for opiate prescriptions for acute pain as soon as the proposed rules are finalized, but will have an additional nine months to begin reporting ICD-10 codes for other controlled substances.  It is expected the boards of medicine, dentistry, and nursing will propose additional rules related to these prescribing standards.

Medical Board Executive Director A.J. Groeber has indicated that the board’s ability to know what conditions Ohio doctors are treating using potentially addictive opiates is “the linchpin” both to effective regulation and education.  Executive Director Groeber went on to state, “It’s not just about going after the bad actors. We want to be able to do that, but we also want to educate the vast majority of our well-intentioned licensees to make sure that they know that they can treat patients effectively with fewer pills and fewer days’ supply.” i

While the proposed rules will permit an Ohio pharmacist acting in good faith to dispense a controlled substance even if the prescription lacks a diagnosis code, pharmacies that dispense and prescribers who personally furnish controlled substances will be required to transmit the diagnosis code to Ohio’s prescription drug monitoring program, also known as OARRS.  The pharmacy board, which oversees the OARRS program, will contact prescribers who issue controlled substance prescriptions without a diagnosis code.  In light of the comments from the medical board’s executive director, prescribers should anticipate additional follow-up from their licensing boards.

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About this Author

Eric J. Plinke, Dinsmore Law, Health Care Lawyer, Corporate Attorney
Partner

Eric Plinke is a Partner in the Corporate Department and Health Law Practice Group, and he routinely advises corporate and individual clients regarding a wide-range of health care industry legal issues. He has counseled clients in practice formation and acquisition, hospital and joint venture transactions, hospital and medical practice affiliations, contract review and preparation, compliance programs, HIPAA regulations, scope of practice issues, telemedicine and Stark law and Anti-kickback statutes, as well as significant experience counseling in ambulatory surgery centers and other joint...

614-227-4213
Daniel S. Zinsmaster, Dinsmore Law Firm, Health Care Lawyer
Partner

Dan provides trusted counsel and advocacy to health care clients on a variety of matters, such as corporate compliance, provider credentialing, administrative proceedings and litigation.  He also advises clients on practice formation and acquisition, as well as contract review and preparation.  In recent years, Dan has helped health care companies and providers navigate through fraud and abuse investigations, antitrust reviews, and other white collar criminal matters.  He is a frequent author and lecturer on telehealth and telemedicine issues.

Prior to joining Dinsmore, Dan practiced for nearly seven years with the State Medical Board of Ohio, where he advised board members and agency personnel on issues related to the Medical Practices Act of Ohio, Chapter 119 Administrative Procedures, and federal rules and regulations implicating the area of health care.  His substantial regulatory experience enables him to bring a unique and insightful perspective to handling diverse and complex health care matters, and his thorough understanding of health care laws and policies helps him serve as a valuable resource to corporations, health care associations, hospitals, medical practices and individual practitioners. 

In addition to his experience with federal and state health care regulatory agencies, Dan has successfully aided clients appearing before a number of other administrative or executive entities, including the Ohio Department of Commerce, Accountancy Board of Ohio, and the Ohio Board of Registration for Professional Engineers and Surveyors.  He previously served as an extern for the Legal Office of the Ohio governor, as well as the Business & Regulations Division of the Columbus city attorney’s office.

(614) 628-6949
Sarah C. Persinger PharmD RPh, managed care lawyer & pharmacy benefits management attorney at Dinsmore Law Firm
Associate

Sarah is a member of our Health Care Practice Group. She holds a Doctor of Pharmacy degree and is a registered pharmacist with extensive pharmacy practice experience and a working knowledge of regulatory affairs. She has managed health system pharmacy compliance with Ohio State Board of Pharmacy, DEA, and CMS regulations, the federal 340B Drug Discount Program, USP 797 and FDA Sterile Compounding requirements, and Joint Commission and HFAP Accreditation standards. 

Sarah has a strong working knowledge of specialty pharmacy, managed care and...

(614) 628-6979